The healthcare debate is unhealthy. It drowns us in a sea of words, numbers, and angry shouts, and causes us to forget the topmost problem: US healthcare costs more, but it does less.
For decades now, the world’s richest country, the beacon of modern technology has been, pardon the word, ripped-off. Although the United States spends more than any other country on health care (18% of GDP), Americans have a shorter life expectancy than all other citizens of the First World:
(For more, go to ourworldindata.org. The work of Max Roser, a German-born economist currently in Oxford, the site is a treasure of data and sources. I hope to meet him some day and convince him to come to Stanford.)
Why are we being taken advantage of? Or, more precisely, why are we allowing ourselves to spend so much for mediocre results?
The answer is simple—and a cause for despair.
Our culture says healthcare is an ordinary commodity, like soft drinks, cars, or smartphones. In a Mar. 7 CNN interview, representative Jason Chaffetz made the notion explicit when he blurted that Americans should invest in their own healthcare rather than buy a new iPhone:
The congressman tried to walk back his too-honest statement, but the thought was out of the box: Healthcare belongs to the same category as any other good or service.
No.
As the late business sage Peter Drucker pointed out in his seminal work Management (available here in PDF form), there’s a fundamental difference between Business and Institutions. They cannot be run with the same ideas, emotions, goals, and measurements: “The service institutions are not businesses; performance means something quite different in them.”
Should the Justice Department or the Army be run for profit, like a business? We know what happens when police departments use citations to generate revenue, or use the scoundrel Forfeiture Laws to fill their coffers.
Looking back at the life expectancy vs. health expenditure chart, one notes that most of the countries that outperform us follow Drucker’s edict and don’t treat healthcare as if it were just another business. Of course, doctors need to make money, hospitals need to be solvent, and pharmaceutical companies must generate funds for research—yet everyone is covered. None of these other systems is perfect, of course—they’re wasteful in places and unpleasant in others—but they cost less and provide better outcomes. I know the French system reasonably well, warts and all, and could regale you with personal anecdotes of the overall scene. What really counts, though, is that for all its abuse, disorganization, and angry disputes, the French system works much better than what we have here. Even better examples can be found in the Scandinavian countries and Germany.
Our difference is rooted in culture, whose permissions to emote, think, say, and do are often buried in the deepest recesses of our psyche—and taken for the Truth.
Imagine for a moment I’m born in another country. There, I’m raised as a strict member of the local religion, go to a rightful school, commit the Creed’s scriptures to memory, and regularly chant them in their original ancient language. I know the Truth and, as a result, am horrified by a number of Western behaviors ranging from relationships between the sexes to food and drink.
Of course, we Westerners know better. Our Truth is the Real Truth.
Such certainty apples to our healthcare culture. Our way is right and immutable; anything else is demonized as “socialism.” This attitude is distressing; we can’t admit that we’re wrong—that we aren’t doing a very good job of taking care of all of our citizens, rich and poor—and that perhaps a little bit of socialism, à la Scandinavia and Germany, might be a good thing.
But is it true that we don’t have “socialized medicine” at all? Out of curiosity, I tweeted an inquiry about the healthcare coverage of Members of Congress. Paul Maxime and Kontra directed me to this benefits brief (PDF) and these guidelines for federal employee health benefits. As you’ll see for yourself, they’re rather impenetrable.
I pasted the links into the search field of my Tweetbot app. The results were spectacular—a long list of angry tweets. It appears our solons are well taken care of by We The People: We subsidize somewhere between 72% and 75% of our representatives’ health insurance premiums. As many of the commenters asked, “Why can’t we all get that deal and be done with the silliness?”
Instead we get two competing stories.
On the one hand, our new president has insisted, on 60 Minutes and elsewhere, that his plan (he apparently doesn’t want it called Trumpcare) would be simple, “beautiful,” everybody on board, less expensive, plenty of choices. We’re no longer referring to the rhetoric of campaign promises but to utterances by a sitting president making commitments to the nation.
On the other, we have an unscrutinized, unmeasured for-cost plan that’s apparently ready to move from the House to the Senate where it might encounter opposition and edits. You can read all about it here.
So I did. I downloaded the file and attempted to read the 123 pages. Most look like this:
Now you know why I despair.
PS: Out of remorse for my dark views above, I invite you to go and enjoy the Ignorance Project video. It might shore up your mood.